Subjective and objective survival prediction in mechanically ventilated critically ill patients: a prospective cohort study

被引：0

作者：

Boeck, Lucas ^{[1
,2
]}

Pargger, Hans ^{[3
]}

Schellongowski, Peter ^{[4
]}

Luyt, Charles-Edouard ^{[5
,6
]}

Maggiorini, Marco ^{[7
]}

Jahn, Kathleen ^{[1
]}

Muller, Gregoire ^{[5
]}

Loetscher, Rene ^{[8
]}

Bucher, Evelyne ^{[3
]}

Cueni, Nadine ^{[3
]}

Staudinger, Thomas ^{[4
]}

Chastre, Jean ^{[5
]}

Siegemund, Martin ^{[1
,3
]}

Tamm, Michael ^{[1
]}

Stolz, Daiana ^{[1
,9
]}

机构：

[1] Univ Hosp Basel, Dept Clin Res, Basel, Switzerland

[2] Univ Basel, Dept Biomed, Basel, Switzerland

[3] Univ Hosp Basel, Dept Acute Med, Intens Care Unit, Basel, Switzerland

[4] Univ Hosp Vienna, Dept Internal Med 1, Vienna, Austria

[5] Sorbonne Univ, Assistance Publ Hop Paris, Inst Cardiol, Med Intens Reanimat,Grp Hosp Pitie Salpetriere, Paris, France

[6] Sorbonne Univ, ICAN Inst Cardiometab & Nutr, UMRS 1166, INSERM, Paris, France

[7] Univ Hosp Zurich, Dept Internal Med, Intens Care Unit, Zurich, Switzerland

[8] Kantonsspital Baselland, Surg & Med Intens Care Med, Liestal, Switzerland

[9] Univ Freiburg, Fac Med, Med Ctr, Dept Pneumol, Freiburg, Germany

来源：

CRITICAL CARE | 2023年 / 27卷 / 01期

基金：

瑞士国家科学基金会;

关键词：

Risk stratification; Personalised medicine; Critical care; Scores; Outcome; Modelling; INTENSIVE-CARE-UNIT; HOSPITAL MORTALITY; ICU; FAILURE; DISEASE; SCORE; CLASSIFICATION; PHYSICIANS; PROGNOSIS; SEVERITY;

D O I：

10.1186/s13054-023-04381-1

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Background ICU risk assessment tools, routinely used for predicting population outcomes, are not recommended for evaluating individual risk. The state of health of single patients is mostly subjectively assessed to inform relatives and presumably to decide on treatment decisions. However, little is known how subjective and objective survival estimates compare. Methods We performed a prospective cohort study in mechanically ventilated critically ill patients across five European centres, assessed 62 objective markers and asked the clinical staff to subjectively estimate the probability of surviving 28 days. Results Within the 961 included patients, we identified 27 single objective predictors for 28-day survival (73.8%) and pooled them into predictive groups. While patient characteristics and treatment models performed poorly, the disease and biomarker models had a moderate discriminative performance for predicting 28- day survival, which improved for predicting 1-year survival. Subjective estimates of nurses (c-statistic [95% CI] 0.74 [0.70-0.78]), junior physicians (0.78 [0.74-0.81]) and attending physicians (0.75 [0.72-0.79]) discriminated survivors from non-survivors at least as good as the combination of all objective predictors (c-statistic: 0.67-0.72). Unexpectedly, subjective estimates were insufficiently calibrated, overestimating death in high-risk patients by about 20% in absolute terms. Combining subjective and objective measures refined discrimination and reduced the overestimation of death. Conclusions Subjective survival estimates are simple, cheap and similarly discriminative as objective models; however, they overestimate death risking that live-saving therapies are withheld. Therefore, subjective survival estimates of individual patients should be compared with objective tools and interpreted with caution if not agreeing. Trial registration ISRCTN ISRCTN59376582, retrospectively registered October 31st 2013.

引用

页数：10